Methods of Reconstruction
There are three methods of reconstruction:
- Reconstruction using implants
- Reconstruction using the patient’s tissue only (‘autologous’ reconstruction)
- Reconstruction using the patient’s tissue combined with an implant
If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts. Of course, forgoing any reconstruction after mastectomy is always an option.
Now? Or later?
Reconstruction can be either immediate (at the same time as the mastectomy) or delayed (at a later time). This decision may be dictated by the characteristic and stage of the breast cancer, and will be made together with your breast surgeon.
Immediate reconstruction has been shown to be a safe option for many women. In this type of reconstruction, the breast mound creation is done at the same time as the mastectomy. This can help minimize the negative effect that a mastectomy can have on body image and self-esteem. Immediate reconstruction also reduces the number of anesthetics (operations) required to complete the reconstruction. If you are interested in beginning reconstruction at the time of mastectomy, you must ask your breast surgeon to make a referral for you to see a plastic surgeon.
Delayed reconstruction is performed several weeks, months or even years after the mastectomy occasionally after other cancer treatments are finished. The timing of reconstruction following the completion of radiation therapy should be discussed with your specific reconstructive surgeon.
Breast Reconstruction Using Implants
First, a temporary device known as a tissue expander is placed in the breast to create the soft pocket that will contain the permanent implant. Once expansion is complete, the expander will be exchanged for the permanent implant during an outpatient procedure.
The approach allows for a breast implant to be placed immediately following mastectomy, foregoing the need for a tissue expander. Some patients may still require a secondary procedure.
There are several types of Flap reconstructions available:
- TRAM Flap (Donor Site: Abdomen) – This is a method of tissue reconstruction which uses the pedicled transverse rectus abdominus myocutaneous (TRAM) flap. In this approach, abdominal muscle, tissue, skin, and fat are used to create breast shape. The patient will have the benefit of a somewhat flatter looking abdomen. The scar on the abdomen is low and extends from hip to hip.
- LDP Flap (Donor Site: Back) – The latissimus dorsi (LD) flap is most commonly combined with an implant. At the time of breast reconstruction, the muscle flap, with or without attached skin, is removed from the back and implanted in the breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape compared to an implant alone. The scar on the back can often be concealed under a bra strap.
- DIEP Flap (Donor site: Abdomen) The Deep epigastric artery perforator (DIEP) free flap uses skin and fat from the abdomen, to create a breast shape. This type of reconstruction spares the abdominal muscles and harvests the tissue on a blood vessel perforating the muscle. This technique utilizes microsurgery to reattach the vessels to the chest wall. Similar to the TRAM, the patient will have a flatter appearing abdomen in addition to not harvesting either of the abdominal muscles.
- GAP Flap (Donor Site: Buttock) – The gluteal artery perforator (GAP) free flap uses skin and fat from the buttocks to create a breast shape. This type of reconstruction uses microsurgery to attach the tissue to the chest wall. The tissue from the buttock is removed, typically leaving a scar in the upper portion of one side of the buttocks, concealed under the panty line.
- Inner Thigh Free Flap (Donor Site: Thigh) – This procedure uses skin, fat, and muscle from the inner portion of the upper thigh to reconstruct the breast. The tissue is dissected from the inner thigh and transplanted to the chest where it is reattached using microsurgery. The resulting thigh scar is generally well hidden.
It is important for you to be aware that a reconstructed breast will not have the same sensation and feel as the breast it replaces. And, visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
Making Sure You’re Covered
Under the Federal Women’s Health and Cancer Rights Act of 1998, health insurance plans that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. This coverage includes reconstruction of the breast removed by mastectomy, reconstruction of the other breast to produce symmetrical appearance, breast prostheses, and treatment of physical complications at all stages of the mastectomy.
It is recommended that you confirm your exact coverage with your health insurance carrier before scheduling any surgical procedures.
If you have had a mastectomy and are considering reconstruction or if you are preparing for a mastectomy and would like to discuss your breast reconstruction options, surgeons are Carle Plastic Surgery Center are available for consultation to discuss the options that are best for you.
To schedule your consultation, please call (217) 326-2000.
Source: Breast Reconstruction Awareness Day; American Society of Plastic Surgeons; retrieved October 2015 from breastreconusa.org.